Capgras Syndrome and Other Delusions of Misidentification: Integrating Neuropsychological Models of Delusion Formation with Psychoanalytic Object-Relations Theory

Purpose of Review We show how psychoanalytic object-relations theory (PsyObjT) aligns with recent neuropsychological theories of delusions of misidentification (DMI), including the four-level model postulated by Feinberg (Conscious Cogn 20(1):75-81, 11), to enhance our understanding of these complex and fascinating delusions. Recent Findings We explain the mixed phenotypical expressions of DMI (Capgras, Fregoli, re-duplication, inter-metamorphosis, and mirrored-self misidentification) as combinations of disturbances of the fundamental attributes of the uniqueness, permanence, authenticity, and familiarity of mental representations of people and objects. Summary Delusions of misidentification (DMI) involve striking disruptions of essential mental processes, including the maintenance of stable mental representations of the self and others. We introduce this article with a brief report of a patient with features of both Capgras syndrome and delusions of re-duplication. After providing a brief overview of PsyObjT, which describes the psychological origins of mental representations of the self and others, we describe how the complimentary perspectives of neuropsychology and modern PsyObjT explain how the classic DMI syndromes take shape in the mind. The companion article in this issue (Leighton et al.) synthesizes neuropsychological models of DMI. We recommend it as an introduction to this contribution.